Co-Principal Investigator: Kern, Lee

Purpose: The purpose of this project was to further develop and refine a parent education program to increase parent engagement with early intervention for young children with ADHD as well as develop an alternative format (web-based) of parent education to increase parent accessibility and engagement with the intervention. Attention-deficit/hyperactivity disorder (ADHD) in young children is associated with significant impairment in behavioral, social, and pre-academic functioning, with affected children approximately 2 standard deviations below their non-ADHD counterparts in all three areas. Additionally, ADHD tends to be chronic, with research suggesting that at least 70 to 80 percent of preschool-aged children with this disorder will continue to exhibit significant ADHD symptoms during elementary school. One promising approach to intervention in the early years is to train parents to help address the issues of young children exhibiting early behavioral symptoms of ADHD. However, two major issues seem to limit the effectiveness of parent education programs: (1) the extensive time commitment (number of sessions) of many of the programs appears to severely hinder parent completion and (2) none of the parent education interventions have specifically targeted the multiple challenges that children with ADHD experience, such as poor parent-child interactions, difficulty with pre-academic skills, and a high injury rate. Ultimately, this project aimed to develop a more consistent implementation of effective behavioral strategies for preschoolers though the development and pilot testing of Promoting Engagement of ADHD pre-Kindergartners (PEAK).

Project Activities: Research activities were conducted across three phases. During Phase 1, the prior version of this parent education program was modified and streamlined, with the goal of increasing and maintaining parent engagement. During Phase 2, a web-based format of the revised parent education program was developed and refined, which also aimed to increase and maintain parent engagement. Phase 3 compared parent engagement, implementation fidelity, and child outcomes between an in-person parent education group, web-based delivered parent education group, and wait-list control group.

Key Outcomes:

• The pilot study indicated that both face-to-face and online versions of PEAK led to significant improvements in parent knowledge and implementation of behavioral interventions as well as parent ratings of child behavioral self-control, mood, and restlessness/impulsivity for families of children at risk for ADHD (DuPaul, Kern, Belk, Custer, Daffner et al., 2018).
• The streamlined 10-session version of the face-to-face behavioral parent education program PEAK was rated as acceptable, feasible, and effective by parents of young children at risk for ADHD (DuPaul, Kern, Belk, Custer, Hatfield et al. 2018).
• Parents of young children at risk for ADHD reported that the modified, asynchronous, online format of PEAK was acceptable, feasible, and effective (DuPaul, Kern, Belk, Custer, Hatfield et al., 2018).

Products: The products of this project include a fully developed, streamlined, and targeted parent education program in two formats (face-to-face and web-based) for parents of young children with significant symptoms of ADHD; evidence of the feasibility and promise of the intervention; and peer-reviewed publications.

Structured Abstract

Setting: The research took place in Pennsylvania, with parent education sessions conducted in community settings (such as school or health care office). Data were collected in parent education sessions and in family homes.

Sample: Children identified with significant symptoms of ADHD between the ages of 3 and 6 participated. A total of 67 children and their parents participated across all phases of the study (12 in Phase 1, 8 in Phase 2, and 47 in Phase 3).

Intervention: The parent education program, Promoting Engagement of ADHD pre-Kindergartners (PEAK), targeted areas that are specifically problematic for young children with symptoms of ADHD: poor parent-child interactions, difficulty with pre-academic skills, and a high injury rate. The intervention was implemented across 10 weeks, with each weekly session lasting about 2 hours. Session format included didactic presentation of core content facilitated by PowerPoint slides and video-clip illustrations, with parent discussion, modeling, and role play interspersed throughout the session to facilitate understanding and practice strategies. In Phase 2, the intervention was converted to a web-based format in a manner that maintains essential elements of the face-to-face program, enhances parent engagement through the use of multimedia approaches and interactive activities, and provides opportunities for parents to submit questions.

Research Design and Methods: In Phase I, the research team gathered input from a community development team consisting of relevant stakeholders (parents, preschool teachers, early interventionists, developmental pediatricians, and social workers) regarding the content of the existing parent education program. The input was used to develop and refine the intervention into a condensed but targeted 10-week intervention with an accompanying manual. This draft intervention was field tested, revised based on results of the field test (child outcomes, parent feedback, observations of parent implementation of the intervention), tested again with a different cohort of families, and then refined based on the results of this second field test. In Phase 2, the intervention was converted into the web-based format, and the web version was then tested and revised based on user input. In Phase 3, participating parents were randomly assigned to one of three conditions — wait-list control, face-to-face parent education, or web-based parent education — and outcomes were compared.

Control Condition: In Phase 3, a wait-list control condition, prior to receipt of the intervention, was included to facilitate comparisons with the face-to-face and web versions.

Key Measures: Measures included community development team and parent ratings of intervention components; frequency of attendance/completion of parent education sessions; observation of parent adherence with prescribed intervention components; parent ratings of effectiveness, feasibility, and acceptability of the intervention; parent ratings and observations of child behavior; standardized measures of child reading and math achievement; and parent preferences for face-to-face or web-based parent education.

Data Analytic Strategy: Descriptive analyses were aimed at assessing parent education process variables that are related to parent engagement with the intervention. Repeated measures analyses of variance were used in the pilot randomized trial to assess whether the face-to-face and web groups differed on parent and child outcome measures relative to each other and relative to the wait-list control group.

Project Website: http://ed.lehigh.edu/peak

Related IES Projects: Early Intervention for Young Children At Risk for ADHD: Evaluating Efficacy and Delivery Format for Behavioral Parent Education (R324A200010)

Products and Publications

Journal article, monograph, or newsletter:

DuPaul, G.J., Kern, L., Belk, G., Custer, B., Daffner, M., Hatfield, A., & Peek, D. (2018). Face-to-face vs. online behavioral parent training for young children at-risk for ADHD: Treatment engagement and outcomes. Journal of Clinical Child and Adolescent Psychology, 47(sup1), S369-S383.

DuPaul, G.J., Kern, L., Belk, G., Custer, B., Hatfield, A., Daffner, M., & Peek, D. (2018). Promoting parent engagement in behavioral intervention for young children with ADHD: Iterative treatment development. Topics in Early Childhood Special Education, 38, 42-53.